SIS.NET: a randomized controlled trial evaluating a web-based system for symptom management after treatment of breast cancer.

BACKGROUND: As cancer survivorship increases, health care systems will be challenged to meet patient needs. With the limited availability of clinician time and resources, novel methods of using patient-reported outcomes may improve the quality and efficiency of follow-up care in patients with breast cancer. METHODS: The authors conducted a randomized trial in patients with TNM stage I to III breast cancer comparing standard care with SIS.NET (System for Individualized Survivorship Care, based on patient self-reported data, with review by Nurse practitioners, targeted Education, and Triage), a follow-up protocol including integration of online health questionnaires at 3-month intervals and the evaluation of self-reported symptoms monitored and addressed remotely by a nurse practitioner (NP). The primary endpoint was to quantify the time between symptom reporting and remote evaluation of symptoms. The secondary endpoint was to compare use of health care resources (breast cancer-related visits, total medical appointments, and laboratory and imaging studies) over an 18-month period. RESULTS: A total of 102 participants were enrolled; 2 patients were excluded due to cancer recurrence. In the SIS.NET arm, 74% of new or changed self-reported symptoms were reviewed by a NP in <3 days. SIS.NET patients reported more new or changed symptoms compared with standard care patients (7.36 vs 3.2; P = .0045). During the 18-month trial, there were no statistically significant differences noted between the SIS.NET and standard care arms with regard to oncology-related appointments (mean, 4.2 vs 4.1 appointments), number of physician visits (mean, 10.8 vs 9.6 visits), or medical tests (mean, 5.5 vs 5 tests). CONCLUSIONS: Integration of online health questionnaires with remote review by a NP facilitated symptom reporting and may provide a means of convenient symptom assessment, but it did not appear to reduce health care resource use.

Survivorship clinic group educational sessions: adoption, acceptance, and attendance.

The number of breast cancer survivors now exceeds 2.5 million in the USA. In the near future, it is likely that existing systems will not be sufficient to provide follow-up care and services for all these patients. Because survivors have many concerns in common and providers may not have enough time to address them individually, group educational sessions (GES) provide an opportunity to inform patients of current breast cancer-related health issues, treatment updates, and follow-up guidelines in an efficient and structured environment. At the University of California San Francisco Breast Care Center, we implemented a GES for patients referred into the Survivorship Clinic. To improve content and convenience, patients were asked at the end of each session to complete a survey measuring their satisfaction with the GES. Clinic staff tracked GES attendance, reasons for declining participation in the GES, and utilization of the Survivorship Clinic for follow-up care. Of the 381 patients referred to the Survivorship Clinic, 177 patients have attended the GES, and 204 ultimately have not attended the GES. Eighty four of the 177 patients who attended completed a survey at the end of the GES. Ninety-five percent of these patients agreed or somewhat agreed that the information presented was clear and understandable. Eighty-five percent of patients agreed or somewhat agreed that they learned about resources for recovery. Utilization of follow-up appointments within the Survivorship Clinic was significantly higher among those who attended the GES compared to those who did not attend. Overall, the GES allows for efficient patient education, and evaluation of the GES leads to new innovations to improve survivorship care.